Corticosteroids Flashcards
(16 cards)
What are some conditions which require corticosteroids?
- Ulcerative colitis/Crohn’s disease
- Haemorrhoids
-postural hypotension in automatic neuropathy
-raise intercrainial pressure ore cerebral odema from malignancy - hypersensitivity/anaphylaxxis
- asthma
- autoimmune hepatitis, rheumatoid arthritis and sarocoidosis
MHRA advice for corticosteroids
Chorioretniopathy
Retinal disorder with local and systemic use
Recently reported through admin routes - inhalation,intrnasal,topical and epidural
Report any blurred vision or visual disturbances
Refer to an ophthalmologist
What is mineralcorticoid activity and what is glucocorticoid mineral activity?
Mineral = water (hold sodium,potassium,calcium and fluid retention/balance)
Glucocorticoid activity = anti inflammatory/reduced immune response
Examples of glucocorticoid activity and mineralcorticoid activity
Mineral - fludrocortisone, hydrocortisone ( can be both)
Glucocorticoid - Betamethasone, dexamethasone,methyprednisolones,prednisolone, triamcinolone
Side effects of glucocorticoids?
Diabetic body builders are psychos that get stomach ulcers by eating broken bones
- diabetes (glucocorticoids - glucose)
- Muscle wasting (proximal myopathy) can also occur
- Psychiatric reactions
- Linked with peptic ulcers and perforation
- osteoporosis - especially in elderly and result in fractures
Mineralcorticoid - where sodium goes water flows
- hypertension - so we give for hypotension
- sodium retention
- water retention
- potassium loss
- calcium loss
- mineralcorticoid most activity is fludrocortisone
- mineralcorticoid action are negligible with high potency glucocorticoids (betamethasone and dexamethasone)
The best glucocosteroids are ones that have the least mineral corticoid activity
That’s because we want it to reduce inflammation but at the same time not cause water retention -as a side effects - so we want zero mineralcorticoid effects
What is adrenal suppression?
A condition in which the adrenal glands do not produce an adequate amount of corticosteroids - primarily cortisol but also aldosterone (mineralcorticoid) which regulates Na+, K+ and water retention
80% is due to addisons disease
Addison’s = neeed to add steroids
Cushing = stop the steroids they’re crushing you
Signs and symptoms of adrenal suppression
- salt cravings
- hyponatraemia
- weight loss
- hypokalemia
- fatigue
- nausea and vomitting
- hypotension
- anorexia
How do we minimise corticosteroid side effects?
- lowest dose for shore test period of time
- give as a single dose in the morning
- use local treatment vs systemic
- give short course
- use large volume devices and spacers if high dose required to increase airway deposition and reduce oropharyngeal deposition
Replacement therapy
- the adrenal cortex secretes hydrocortisone - cortisol and aldosterone
- hydrocortisone (cortisol) has glucocorticoid and weak mineralcorticoid activity
- aldosterone is a mineralocorticoid
- deficiency = phsycological replacement best achieved with combo of hydrocortisone and fludrocortisone as hydrocortisone alone doesn’t provide enough mineralcorticoid activity for complete replacement
Glucocorticoid therapy
- high glucocorticoid activity is only of benefit when it is accompanied by low mineralcorticoid activity
- fludrocortisone has a very high mineralcorticoid activity but not clinically relevant anti inflammatory activity
- prednisolone has a predominantly glucocorticoid activity, most commonly used by mouth for long term disease suppression
Betamethasone and dexamethasone
Very high glucocorticoid activity and insignificant mineralocorticoid activity
This makes Betamethasone and dexamethasone more suitable for high dose therapy in conditions where fluid retention is not required
- they also have a long duration of action
More general side effects
- MHRA - blurred vision and visual disturbances
- adrenal suppression = caused by prolonged use
- abrupt withdrawal
- patients on long term corticosteroid treatments should carry a steroid card with the,
- infection: prolonged use - increase in susceptibility to infections and severity
- fungal or viral ocular infections may be exacerbated
- serious infections eg. Septicaemia and TB may be recognised when already at an advanced stage because clinical presentation may be atypical
- Psychiatric disturbances and suicidal thought s
- chicken pox - patients at risk of severe chickenpox unless they’ve already had it
- passive immunisation with varicella zoster immunoglobulin is needed
- measles - avoid exposure to measles and seek advice if contact is made
- also other muscoskeletal and ophthalmic effects
Pregnancy
- benefits out weigh risk
Cessation - gradual vs abrupt?
Gradually withdraw for patients whose disease is unlikely to relapse and have:
- received more than 40mg prednisolone or equivalent daily for more than a week
- have had repeated evening doses
- received more than 3 weeks of treatment
- recently received repeat courses - especially if taken for more than 3 weeks
- taken a short course within 1 year of actually stopping long term therapy
- other causes of adrenal suppression
